Michael Ostapchuk

Introducing Practice-Based Learning and Improvement ACGME Core Competencies into a Family Medicine Residency Curriculum

BACKGROUND The Accreditation Council for Graduate Medical Education (ACGME) recommends integrating improvement activities into residency training. A curricular change was designed at the Department of Family and Community Medicine, University of Louisville, to address selected ACGME competencies by incorporating practice-based improvement activities into the routine clinical work of family medicine residents. METHODS Teams of residents, faculty, and office staff completed clinical improvement projects at three ambulatory care training sites. Residents were given academic credit for participation in team meetings. After 6 months, residents presented results to faculty, medical students, other residents, and staff from all three training sites. Residents, staff, and faculty were recognized for their participation. PROGRAM EVALUATION Resident teams demonstrated ACGME competencies in practice-based improvement: Chart audits indicated improvement in clinical projects; quality improvement tools demonstrated analysis of root causes and understanding of the process; plan-do-study-act cycle worksheets demonstrated the change process. CONCLUSIONS Improvement activities that affect patient care and demonstrate selected ACGME competencies can be successfully incorporated into the daily work of family medicine residents.

Improving residents’ teaching skills: A program evaluation of residents as teachers course

Background: The role of residents as teachers is recognized as an important part of medical education. However, residents may not possess the practical skills needed to teach medical students effectively. Aim: In response to a Liaison Committee on Medical Education citation concerning surgery residents’ teaching skills, the University of Louisville School of Medicine instituted a campus-wide residents as teachers program based on the bringing education and service together curriculum. Methods: This evaluation plan is grounded on Kirkpatricks four levels model. Levels 1 and 2 data included post-session learner questionnaires (2007 and 2008) and open-ended facilitator questionnaires (2008). Levels 3 and 4 data included third year medical students’ responses to CourseEval® questions on residents as teachers (2005–2006 and 2007–2008) and data from third year medical student focus groups (2008). Results: Levels 1 and 2 data analysis showed statistically significant improvements from session to session in Year I and significant improvements between Years I and II. Levels 3 and 4 data analysis showed third year students’ perceptions of most residents as teachers remained high and improved significantly in the surgery clerkship. Conclusion: Short-term and long-term measures show this curriculum to be successful for an interdisciplinary group of residents.

The Responsible Use of Online Social Networking: Who Should Mentor Medical Students

Background: As medical students become more active in online social networking (OSN), there are increasing concerns regarding violations of patient privacy and a lack of professionalism. Purpose: Students need to be mentored, but who is best suited to the task? We hypothesized that residents are closer to students in usage and attitudes toward online communication than are faculty. If so, they would be more credible as mentors. Methods: We surveyed faculty (N = 16), 1st-year residents (N = 120), and 3rd-year medical students (N = 130) to compare attitudes about OSN and the online usage patterns. Results: We found residents to be more like students in usage patterns of personal electronic media and in their choice of the mentoring techniques that should be used. Conclusion: Residents say they were not prepared to mentor students without additional guidance but were more confident than faculty members that they had the knowledge to do so.

Using Motivational Interviewing for Smoking Cessation in Primary Care

Objectives To compare the effects of resident physician motivational interviewing (MI), resident physician MI plus registered nurse (RN), and the standard of care counseling approach— ask, advise, assess, assist, and arrange follow-up (5 As)—on current smokers’ behaviors (readiness to quit, cigarettes smoked per day, current smoking rates), self-efficacy to quit smoking, and nicotine dependence. Methods The study design was quasi-experimental pretest/posttest with a comparison group. Pencil/paper measures were completed in the clinic setting at baseline and via telephone approximately 1 and 2 months after the clinic visit. Results There were no differences among the three groups in the proportion of participants who quit smoking, and the stages of change did not differ among the groups or over time. There was a significant time effect and a decrease in the number of cigarettes smoked per day (F2,160 = 41.04, P < 0.001). Significant group × time interactions were present for self-efficacy (F4,140 = 8.20, P < 0.001), nicotine dependence (F4,140 = 6.22, P < 0.001) and satisfaction with clinician (F4,160 = 3.81, P = 0.006). Post hoc analyses showed that participants in the MI groups smoked fewer cigarettes, had higher self-efficacy, and had lower nicotine dependence scores. Only participants in the MD-plus-RN follow-up group had significant positive changes in satisfaction scores. Conclusions Resident physicians who use MI techniques have a tremendous effect on patients’ smoking behaviors. When the resident physician and the RN worked together, participants achieved better outcomes.